In 2017 PT and OT evaluation CPT codes for billing have changed.  There are 3 tiers for each discipline differentiated by complexity.  Below is a listing of each code and description to help you understand the difference.

New Physical Therapy CPT Codes 2017

 

97161 – Physical therapy evaluation: low complexity
Duration: Typically, the PT spends 20 mins. face-to-face with the patient and/or family.
History: The patient has a history of the present problem without any personal factors and/or comorbidities that impact the plan of care.
Examination: The PT completes and examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions. activity limitations, and/or participation restrictions.
Clinical Presentation: The clinical presentation is stable and/or uncomplicated.
Decision-Making: The PT exercises clinical decision-making of low complexity, using a standardized patient assessment instrument and/or measurable assessment of functional outcome.

 

97162 – Physical therapy evaluation: moderate complexity
Duration: Typically, the PT spends 30 minutes face-to-face with the patient and/or family.
History: The patient has a history of the present problem with a history of 1-2 personal factors and/or comorbidities that impact the plan of care.
Examination: The PT completes an examination of body systems using standardized tests and measures addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions.
Clinical Presentation: The clinical presentation is evolving with changing characteristics.
Decision-Making: The PT exercises clinical decision-making of a moderate complexity, using a standardized patient assessment instrument and/or measurable assessment of functional outcome.

 

97163 – Physical therapy evaluation: high complexity

Duration: Typically, the PT spends 45 minutes face-to-face with the patient and/or family.
History: The patient has a history of the present problem with 3 or more personal factors and/or comorbidities that impact the plan of care.
Examination: The PT completes an examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions.
Clinical Presentation: The clinical presentation is unstable with unpredictable characteristics.
Decision-Making: The PT exercises clinical decision-making of a high complexity, using a standardized patient assessment instrument and/or measurable assessment of functional outcome.

 

New Occupational Therapy CPT Codes 2017

 

97165 – Occupational therapy evaluation: low complexity
Duration: Typically, the OT spends 30 minutes face-to-face with the patient and/or family.
History: The patient’s occupational profile and medical and therapy history includes a brief history with review of medical and/or therapy records related to the presenting problem.
Examination: The OT completes an assessment(s) identifying 1-3 performance deficits (i.e., relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions.
Decision-Making: The OT exercises clinical decision-making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number
of treatment options. The patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component.

 

97166 – Occupational therapy evaluation: moderate complexity

Duration: Typically, the OT spends 45 minutes face-to-face with the patient and/or family.
History: The patient’s occupational profile and medical and therapy history includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance.
Examination: The OT completes an assessment(s) identifying 3-5 performance deficits (i.e., relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions.
Decision-Making: The OT exercises clinical decision-making of a moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several
treatment options. The patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is necessary to enable completion of evaluation component.

 

97167 – Occupational therapy evaluation: high complexity

Duration: Typically, the OT spends 60 minutes face-to-face with the patient and/or family.
History: The patient’s occupational profile and medical and therapy history includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance.
Examination: The OT completes an assessment(s) identifying 5 or more performance deficits (i.e., relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions.
Decision-Making: The OT exercises clinical decision-making of a high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. The patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is necessary to enable completion of evaluation component.